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Pharmacoeconomics PharmacoEconomics The costs of diagnosing and treating sexually transmitted infections in low- and middle- income countries from 2006 to 2014: An updated systematic review --Manuscript Draft-- Manuscript Number: Full Title: The costs of diagnosing and treating sexually transmitted infections in low- and middle- income countries from 2006 to 2014: An updated systematic review Article Type: Systematic Review Funding Information: United States Agency for International Not applicable Development (AID-674-A-12-00029) Abstract: Background: Sexually transmitted infections (STIs) are co-factors for HIV infection and can cause significant morbidity. Expanding on a prior systematic review, we aimed to summarize recent literature on the costs of diagnosing and treating curable STIs in low- and middle-income countries (LMICs). Methods: We conducted a systematic review using pre-established search strategies. Citations were eligible if published between 1 January 2006 and 31 December 2014 and if they contained provider-perspective cost information reflective of STI-related service provision in LMICs. We extracted all cost values and used regression analysis to explore determinants. Cost drivers were analyzed thematically. Results: We identified 44 articles for inclusion; 24 (54.6%) represented Sub-Saharan Africa. We extracted 202 cost values; 72 (35.6%) characterized syndromic management approaches, 57 (28.2%) mobile outreach services. Syphilis was a common focus (70 (34.7%)). Sixty-five (32.2%) cost values represented cost- effectiveness measures as compared to simple unit costs. The median for all cost values was (USD 2015) $10.90 (cost-effectiveness measures $115.88; unit costs $4.15). Regression analysis indicated that cost effective measures were lower in Africa than other continents. Comparing unit costs only, costs were lower for mobile services than fixed-site services. Thirty-seven (84.1%) articles discussed cost drivers. Service delivery mode was most common, followed by volume/scale, STI incidence/prevalence, drug costs and laboratory costs. Conclusions: Many of the articles reviewed presented partial information. Efforts for accelerating action on STIs in LMICs would benefit from increased availability of information on STI prevalence, effective interventions to address STIs (diagnostic approaches and medications) and costing methodologies and outcomes. Corresponding Author: Naomi Lince-Deroche, PhD Health Economics and Epidemiology Research Office Johannesburg, SOUTH AFRICA Corresponding Author Secondary Information: Corresponding Author's Institution: Health Economics and Epidemiology Research Office Corresponding Author's Secondary Institution: First Author: Naomi Lince-Deroche, PhD First Author Secondary Information: Order of Authors: Naomi Lince-Deroche, PhD Rahma Leuner Calvin Chiu Andrea Teagle Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Sharon Kgowedi Cynthia Firnhaber Order of Authors Secondary Information: Author Comments: To the Editors: On behalf of my co-authors I am pleased to submit the attached manuscript titled: "The costs of diagnosing and treating sexually transmitted infections in low- and middle- income countries from 2006 to 2014: An updated systematic review," for consideration by the Editorial Board at PharmacoEconomics. NLD and CC conceptualized and designed the study. NLD, CC, AT, RL, and SK implemented the study. NLD, RL, and CC conducted the analysis. NLD, CC, RL, and SK drafted the manuscript. All authors read and approved the final manuscript. This work did not require ethical clearance as no human subjects were involved. We declare that we have no conflicting interests related to the research or its potential application. This manuscript was previously submitted to Sexually Transmitted Diseases and reviewed by three peer reviewers. It was rejected. We feel that the comments/objections reflected a limited knowledge of health economics and the value of presenting cost data in manuscripts. Thus, we have not revised the manuscript based on the comments received. We look forward to future communication with the journal. Regards, Naomi Lince-Deroche Suggested Reviewers: David Lewis [email protected] International STI expert, knowledgeable of LMIC settings Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Cover Letter Health Economics and Epidemiology Research Office Unit 2, 39 Empire Road Parktown, Johannesburg, 2193, South Africa Tel +27 (0)10 0017930 A division of the Wits Health Consortium (Pty) Ltd, a wholly owned subsidiary of the University of the Witwatersrand 12 February 2018 The Editors Sexually Transmitted Diseases RE: Submission of manuscript To the Editors: On behalf of my co-authors I am pleased to submit the attached manuscript titled: “The costs of diagnosing and treating sexually transmitted infections in low- and middle-income countries from 2006 to 2014: An updated systematic review,” for consideration by the Editorial Board at PharmacoEconomics. NLD and CC conceptualized and designed the study. NLD, CC, AT, RL, and SK implemented the study. NLD, RL, and CC conducted the analysis. NLD, CC, RL, and SK drafted the manuscript. All authors read and approved the final manuscript. This work did not require ethical clearance as no human subjects were involved. We declare that we have no conflicting interests related to the research or its potential application. This manuscript was previously submitted to Sexually Transmitted Diseases and reviewed by three peer reviewers. It was rejected. We feel that the comments/objections reflected a limited knowledge of health economics and the value of presenting cost data in manuscripts. Thus, we have not revised the manuscript based on the comments received. We look forward to future communication with the journal. Regards, Naomi Lince-Deroche [email protected] Manuscript Click here to download Manuscript Lince-Deroche. STI Dx and Tx Cost 2018.02.12.docx Click here to view linked References 1 1 Title: The costs of diagnosing and treating sexually transmitted infections in low- and 2 3 4 2 middle-income countries from 2006 to 2014: An updated systematic review 5 6 3 7 8 4 Authors: Naomi Lince-Deroche1, Rahma Leuner1, Calvin Chiu1, Andrea Teagle1, Sharon 9 10 1 2, 3 11 5 Kgowedi , Cynthia Firnhaber 12 13 6 14 15 16 7 Author affiliations: 17 18 8 1 Health Economics and Epidemiology Research Office, Department of Internal 19 20 21 9 Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of 22 23 10 the Witwatersrand, Johannesburg, South Africa 24 25 11 2 Right to Care, Johannesburg, South Africa 26 27 28 12 3 Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health 29 30 13 Sciences, University of Witwatersrand, Johannesburg, South Africa 31 32 33 14 34 35 15 Corresponding author: Naomi Lince-Deroche, Health Economics and Epidemiology 36 37 38 16 Research Office, 39 Empire Rd, Parktown, Johannesburg, South Africa 2194, phone: 39 40 17 +27 10 010 0638, email: [email protected] 41 42 43 18 44 45 19 Word counts: Summary 30, Abstract 250, Text 2,999 46 47 20 Number of figures: 4 / tables: 2 48 49 50 21 51 52 22 Running title: Systematic review of STI costs in LMICs 53 54 55 56 57 58 59 60 61 62 63 64 65 23 1 2 24 Acknowledgments 3 4 5 25 The authors gratefully acknowledge contributions from Dr Fern Terris-Prestholt 6 7 26 during the preparation of this manuscript. 8 9 10 27 This study was made possible by the generous support of the American people 11 12 28 through the United States Agency for International Development (USAID), award number 13 14 AID-674-A-12-00029. The contents are the responsibility of the Health Economics and 15 29 16 17 30 Epidemiology Research Office, a Division of the Wits Health Consortium (Pty) Ltd and do 18 19 31 not necessarily reflect the views of USAID or the United States Government. 20 21 22 32 23 24 33 Key points: 25 26 27 34 A systematic review of literature published from 2006-2014 of sexually 28 29 35 transmitted infection (STI) screening and treatment costs in low- and middle- 30 31 32 36 income countries found that data are lacking on specific interventions and 33 34 37 costing methodologies. 35 36 37 38 A meta-analysis of available data produced a median cost value of (USD 38 39 39 2015) $10.90 (cost-effectiveness measures $115.88; unit costs $4.15). 40 41 42 40 Regression analysis indicated that cost effective measures were lower in 43 44 41 Africa than other continents. 45 46 42 Considering cost drivers, service delivery mode was most commonly 47 48 49 43 mentioned, followed by volume/scale, STI incidence/prevalence, drug costs 50 51 44 and laboratory costs. 52 53 54 55 56 57 58 59 60 61 62 63 64 1 65 45 Abstract 1 2 46 Background: Sexually transmitted infections (STIs) are co-factors for HIV infection and can 3 4 5 47 cause significant morbidity. Expanding on a prior systematic review, we aimed to summarize 6 7 48 recent literature on the costs of diagnosing and treating curable STIs in low- and middle- 8 9 10 49 income countries (LMICs). 11 12 50 13 14 Methods: We conducted a systematic review using pre-established search strategies. Citations 15 51 16 17 52 were eligible if published between 1 January 2006 and 31 December 2014 and if they 18 19 53 contained provider-perspective cost information reflective of STI-related service provision in 20 21 22 54 LMICs. We extracted all cost values and used regression analysis to explore determinants. 23 24 55 Cost drivers were analyzed thematically. 25 26 27 56 28 29 57 Results: We identified 44 articles for inclusion; 24 (54.6%) represented Sub-Saharan Africa. 30 31 58 We extracted 202 cost values; 72 (35.6%) characterized syndromic management approaches, 32 33 34 59 57 (28.2%) mobile outreach services. Syphilis was a common focus (70 (34.7%)). Sixty-five 35 36 60 (32.2%) cost values represented cost-effectiveness measures as compared to simple unit 37 38 61 costs.
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